When I think of global health issues pertinent to the developing world, I generally think of infectious diseases–like malaria, HIV and tuberculosis. Cancer usually doesn’t come to mind–it’s only a problem for the developed world, right? Wrong.
After attending a lecture today by Her Royal Highness Princess Dina Mired of Jordan (King Hussein Cancer Foundation), it is clear to me that cancer is a global health problem. The lecture also included remarks by Dr. Julie Gralow (Seattle Cancer Care Alliance oncologist and Jill Bennett Endowed Professor in Breast Cancer), Dr. Julio Frenk, (Dean, Harvard School of Public Health and former Health Minister of Mexico) and Dr. Felicia Knaul (Harvard Medical School). It turns out that about 54% of cancer diagnoses and 64% of cancer deaths in the world come from developing countries. By 2030, the percentage cancer deaths that come from developing countries is predicted to go up to 70%. What’s tragic is that many of these deaths are preventable! For example, Acute Lymphoblastic Leukemia has 80-90% survival rate in the western world, while the survival rate in developing countries is around 10%.
Another example is cervical cancer. While cervical cancer related mortality has gone down in the US due to extensive screening, it still a major problem in developing countries. Several years ago, scientists (including some who work across the hall from me) developed a vaccine that prevents a vast majority of cervical cancer by targeting the Human papilloma virus (HPV). HPV infection is the leading cause of cervical cancer. A recent study (written about in the New York Times today) shows that the incidence of HPV infection has significantly decreased in teenagers since the introduction of the HPV vaccine. This is great news for the US as we can also expect rates of cervical cancer to go down. But what about poorer countries? Under the direction of Dr. Julio Frenk, Mexico has implemented health reforms that provide the HPV vaccine free to school-aged girls. This practice is not widespread in most low and mid-income countries though it can help prevent cervical cancer.
Additionally, a fact of life with cancer often is the necessity for palliative care–end of life care that generally involves management of pain. While availability of medicines to manage pain is good in the US, Canada, Australia and the EU, it is a huge problem in developing countries. Sadly, not only will more people die of cancer in developing countries but they will likely die in more pain.
What are the reasons for these disparities?
One obvious reason is access to healthcare facilities that can provide the appropriate care–especially in rural settings. More than just facilities, many places lack well-trained oncologist and other professionals. Princess Dina Mired pointed out that many developing countries send students to the West for studies, but few come back to practice medicine in their home countries for various reasons. Even for patients who have access to healthcare and trained providers, paying for the treatment is problematic. The lecturers today cited that prior to health reforms in Mexico, almost 30% of breast cancer patients never finished cancer therapy (for which their families had already gone into severe debt) because they ran out of money. Of course, financial strain as result of expensive treatment even with insurance can also be a problem here in the US.
There is also a divide in global funding of programs to eradicate infectious diseases vs those that target cancer in developing countries. The Bill and Melinda Gates Foundation and others have made a commendable and effective push to improve survival from infectious diseases. But why has cancer in developing countries been largely ignored by the folks holding the money bags? Perhaps it is because of the myth, which I was guilty of believing, that cancer is only a problem for wealthy countries. I hope the some of the numbers I provided above will convince you this is simply not true.
How do we overcome these disparities to reduce cancer incidence and improve cancer survival in developing countries?
Obvious solutions are improve access to health care, have better trained staff and good equipment, make health care affordable, and get more people to invest in cancer prevention and treatment for developing countries.
So, how do we do that?
What are your solutions?